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Be Aware: A Mild Case of COVID-19 Can Suddenly Turn Severe

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Neha Pathak, MD - Blogs
By Neha Pathak, MDBoard-certified internistApril 02, 2020

Healthcare workers on the frontline are starting to report a disturbing finding when it comes to caring for COVID-19 patients.

Time and again, they are seeing patients who come to the emergency room with “mild symptoms” that can be managed at home; then, 1-2 days later, these patients are back and they’re drastically sicker. One ER doc describes it like this: ”It’s slow, slow, slow, and then bang – people are suddenly really sick and crashing. It can be really scary to see.”

Some patients are describing a similar experience. They may be having mild symptoms like cough, fatigue, and muscle aches for a few days, and then suddenly experiencing severe shortness of breath, making it almost impossible to fill their lungs with air.

Doctors are also finding that some patients report that they are starting to feel a little better after about a week, then over the course of 1-2 days, the symptoms come back with a vengeance requiring higher level care in the hospital – including high levels of oxygen and breathing tube placement.

What does the spectrum of COVID-19 illness look like?

From current data, it looks like about 25-30% of people can be asymptomatic or “pre-symptomatic” spreading COVID-19 without even knowing that they have it. About 80% of people go on to have mild to moderate illness, and don’t go past this stage. But about 16% of people do worsen and go on to have more serious disease.

From what we are seeing in terms of patient’s experiences with COVID-19 it appears that mild symptoms can feel like a cold: runny nose, cough, sore throat. Mild-moderate may feel more like the flu or “walking pneumonia”: wiped out for days, deep, dry cough, fever, shortness of breath, taking a few weeks to recover, potentially needing care in a hospital. Patients with severe-critical cases experience severe shortness of breath, air hunger, deep cough, needing to be hospitalized, needing oxygen, needing ICU level care, needing ventilator, with a high risk for death.

(It’s also important to remember that the list of possible symptoms has grown beyond fever, cough, and shortness of breath; symptoms may also include: headache, runny nose, sore throat, weakness, fatigue, muscle aches and pains, nausea, stomach upset, vomiting, diarrhea, loss of smell and taste, red eyes.)

Who is at higher risk of progressing?

The short answer: We don’t know.

It’s important to know that we don’t yet know who will have a sudden deterioration. It’s happening to people in their 20s-40s and well as people that are older. It’s happening to people that have pre-existing health conditions, and those that are completely healthy before coming down with COVID-19.

Some early trends that we are seeing from the frontlines suggest that most people with mild disease develop symptoms around day 3- 5, start to show signs of recovery in about a week, and fully “recover” by about 2 weeks. Some data suggest that people who go on to have more severe disease (requiring hospitalization) develop worsening symptoms after day 5 or over the course of the second week, from day 7-10 days.

There is also some data showing that people whose symptoms include severe fatigue, headache, abdominal pain, and shortness of breath seem to progress past mild disease, especially if their age is over 60 and they have other health problems (like heart, lung, or kidney disease, cancer, and depressed immune systems).

Another finding that suggests you may have more severe disease is if your breathing rate (the number of breathes in a minute) starts moving up past more than 24 breathes/minute when you are resting. If you are breathing at less than 20 breaths/minute that seems to be more reassuring.

Remember, all of these findings are based on early and limited data.

What should you do to protect yourself?

Because we are seeing the possibility of sudden worsening, with no clear risk factors, it’s critically important to monitor your symptoms multiple times a day if you are isolating at home. Check your temperature, check your breathing rate, monitor your cough, and monitor for worsening shortness of breath.

If you do have any COVID-19 symptoms (whether you have tested positive for COVID-19 or not), watch yourself very closely and let your doctor know quickly if your condition worsens.

Sudden and severe shortness of breath, deep and uncontrollable coughing, dizziness, and chest discomfort are all signs that you need emergency care, so if you experience those symptoms, seek care immediately.

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About the Author
Neha Pathak, MD

Neha Pathak, MD, is a board-certified internal medicine doctor and part of WebMD's team of medical editors responsible for ensuring the accuracy of health information on the site. Before joining WebMD, Pathak worked as a primary care physician at the Department of Veterans Affairs and was an assistant professor of medicine at Emory University in Atlanta.

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